June 2017
More on Vitamins and Dietary Supplements

There are fat soluble vitamins (ADEK), and water soluble vitamins (B and C). Generally the water soluble vitamins are safe as we process out what we do not need through the kidneys. On the other hand, we must be careful with fat soluble vitamins as they are stored in the fat and can accumulate into overdose. Vitamin overdose is uncommon but real. Eat a polar bear’s liver and you die from Vitamin A poisoning that causes swelling of the brain. When I was in Residency the cardiologists were telling everyone to take Vitamin E as an anti-oxidant to prevent heart disease; now the cardiologists are telling their patients to get off Vitamin E as it can cause internal bleeding (especially with aspirin). This raises the issue of reversals in medicine which I will address in an upcoming blog.

We use Vitamin K to reverse the blood thinner Coumadin (warfarin); so too much Vitamin K can lead to fatal clotting. Vitamin D helps us absorb calcium from the diet which is important in the prevention of osteoporosis (demineralized bones). Too much Vitamin D can lead to hypercalcemia; death from Vitamin D poisoning and too much calcium is rare. Also rare in the U.S. (<1000 cases per year) is rickets (osteomalacia) which is bone deformity caused by a Vitamin D deficiency. Vitamin D is obtained from sunlight, egg yolks, and fatty fish. The current recommendation on Vitamin D supplementation is no more than 2000 IU (international units) daily, unless there is a documented deficiency; for Vitamin E it is no more than 1500 IU daily.

Until recently calcium supplementation was recommended to prevent and treat osteoporosis in postmenopausal women. Unfortunately the latest research shows that calcium supplementation leads to calcium deposits on the coronary arteries (another reversal). So the safest way to get calcium is to eat kale, broccoli, cheese and nuts, and to walk regularly in the sun without sunscreen to absorb Vitamin D. Yes, about 12,000 people die each year in the U.S. from skin cancer; but over 185,000 die each year from falls involving osteoporosis. Of course, the leading killer is heart disease with over 600,000 deaths yearly; so depositing calcium on the coronary arteries is not good.

Some research on herbal supplements is done but not much, and usually it is biased science put out by the manufacturers. The National Institute of Health (NIH) does have a small budget provided by Congress for research into alternative medicine, but it has made only a small dent in our vast ignorance. At this time it would appear that the following herbal products may be effective: Saw Palmetto for nocturia; Red Yeast Rice (which is chemically similar to a statin) for hyperlipidemia; St John’s Wort (which is chemically similar to Prozac) for depression; Melatonin for insomnia; Soy, Black Cohosh, or Primrose Oil for hot flashes; garlic for hypertension. Fish oil supplementation was thought to be effective for high triglycerides and is now thought not to be effective (another reversal). Not effective: Cinnamon for diabetes; Coenzyme Q10 for statin induced myopathy; Gingko Biloba for memory. Some herbals act as blood thinners such as Gingko and Ginseng; patients often fail to tell their surgeons that they take herbal supplements as they assume them - falsely - to be safe. Your best bet is to treat them like aspirin and hold them for a week prior to surgery, and hope that you never need emergency surgery.